I.                    book lists 18 of them

• Anti-inflam
• Analgesis
• Antipyretic
• Mechanism unknown, though thought to inhibit prostaglandin synthesis by blocking the enzyme CYCLOOXYGENASE 
• Traditional NSAIDS block both CYCLOOXYGENASE-1, which helps maintain stomach lining, andCOX-2, which triggers pain and inflammation
• Celebrex is celecoxib which doesn not block COX-1 so less GI adv rxns; primarily blocksCOX-2

                                                               i.      Pian of arthritis and other musculoskeletal disorders

                                                             ii.      Mild to moderate pain

                                                            iii.      Menstrual cramps

                                                           iv.      Fever reduction

                                                             v.      The only one I see for mild to severe acute pain is KETOROLAC (generic name)

                                                               i.      GI

1.      Naus/vom, dyspepsia

2.      Anorexia, dry mouth

3.      Diarrhea, constipation

4.      Other GI distress and bloating

5.      Jaundic

6.      Seems to increase with age, esp risk of ulcers in elgerly.  Use smaller doses in elderly

                                                             ii.      CNS

1.      dizziness, anxiety, lightheadedness, vertigo,

2.      headache

3.      drowsiness, insomnis

4.      confusion, depression

5.      stroke and psychic disturbances

                                                            iii.      Cardiovascular

1.      change in bp

2.      arrhthmias

3.      MI

                                                           iv.      Renal

                                                             v.      Hematologic

                                                           vi.      Integumentary

                                                          vii.      Metabolic/Endocrine

                                                        viii.      Sensory/other -- NSAIDS can cause visual disturbances like blurred or diminished, or changes in color vision.  Corneal deposits and retinal disturbances. PCP notified.

                                                               i.      Those with known hypersensitivity to any NSAID

                                                             ii.      Hypersensitivity to aspirin

                                                            iii.      3^rd trimester and during lactation

                                                           iv.      Celebrex = celecoxib contraindicated in those allergic to sulfonamides or hx of cardiac disease or stroke

                                                             v.      Ibuprofen contraindicatied in those with hypertension, peptic ulcer or GI bleeding

                                                           vi.      ALWAYS ASESS cardiovascular disease before giving NSAID

                                                          vii.      Celecoxib never used to relieve postop pain from coronary artery bypass graft

                                                               i.      Preg cat B

                                                             ii.      Elderly heightened risk of ulcer

                                                            iii.      CV disease, hepatic impairment

                                                               i.      Anticoagulants – increase bleed risk

                                                             ii.      Lithium – increases lithium effectiveness, possible toxicity of lithium

                                                            iii.      Cyclosporine – enhances cyclo

                                                           iv.      Anticonvulsants – increases effect of anticonv

                                                             v.      Diuretics – decreased effectiveness of diuretic

                                                           vi.      Antihypertensives – decreases their effectiveness

                                                          vii.      APAP long term use – increases renal impairment

a.       Migraines from cranial vasodilation and stimulation of trigeminal nerves.  Drugs work by activating 5-HT receptors to vasoconstrict and reduce neurotransmission.  These are SELECTIVE SERETONIN AGOISTS. 

b.       believd to be caused by vascular spasms.  Drugs wither prevent these spasms or treat acute pain when occurs.  Those used to prevent are different than those for acute pain.  Preventatives are discussed in other chapters.  The acute pain relievers are discussed below:

                                                               i.      Also, since migraines can cause decreased GI motility, oral drugs may not be absorbed well, so drugs are delivered deifferently: rectal, internasal or subcut injection.

a.       genrerally well tolerated, most common dizziness, nausea, fatigue, pain, dry mouth, and flushing

                                                               i.      Can have cardiovascular effects like MI even, arrythmias, coronary artery vasospasms

                                                             ii.      Can also cause photosensitivity (increases sunburn potential)

• Known hypersensitivity
• Only used with clear migraine dx
• Never use if ischemic heart disease, TIAs, uncontrolled hypertension, or on MAO antidepressants
• Preg Cat C
• Caution to lactating moms
• Those with phenylketonuria cannot take Maxalt and Zomig b/c contains phenylalanine

                                                               i.      cimetidine – increases effect of migraine med

                                                             ii.      birth control – same

                                                            iii.      sibutramine is an appetite suppressant and with 5-HT agoist can cuaseCNS irritability whatever that is

                                                               i.      Preadmin

1.      Allergies to apiprin or any NSIAD, GI disorders, Cardiovascular disease, high BP, hepatic renal fnx.  If problems, report toPCP before admin

2.      Pain assessment

3.      If arthritis, inspect joints and mobility

                                                             ii.      Postadmin

1.      reassess 30-60 min, if persistes, reassess.

2.      If fever persists, may get dehydrated

3.      Reassess joints

4.      Check for adv rxs like prolonged bleeding, dark stools, report toPCP

                                                               i.      Give NSAID with food/milk or antacids

                                                             ii.      May take weeks to reach full effect

                                                            iii.      Since elderly more likely to have arthritis, thus more likely be on NSAIDS longterm, are prone to GI bleeding.  Encourage taking with food and full glass of water